妊娠糖尿病患者孕前身体质量指数、孕期增重及血脂水平对妊娠结局的影响

doi:10.3724/zdxbyxb-2021-0185

浙江大学学报（医学版）

2021, Vol. 50

Issue (3): 320-328 DOI: 10.3724/zdxbyxb-2021-0185

专题报道

妊娠糖尿病患者孕前身体质量指数、孕期增重及血脂水平对妊娠结局的影响

徐恒(

),马燕,张丽霞,梁朝霞,陈丹青*(

)

浙江大学医学院附属妇产科医院产科，浙江杭州 310006

Impact of pre-pregnancy body mass index, weight gain and blood lipid level during pregnancy on pregnancy outcome in patients with gestational diabetes mellitus

XU Heng(

),MA Yan,ZHANG Lixia,LIANG Zhaoxia,CHEN Danqing*(

)

Department of Obstetrics, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China

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摘要：

目的：探讨妊娠糖尿病（GDM）孕妇及非GDM孕妇孕前身体质量指数（BMI）、孕期增重及孕期血脂水平对妊娠结局的影响。方法：选取2018年1月至2019年4月在浙江大学医学院附属妇产科医院产检并分娩的单胎、孕前无糖尿病、高血压疾病的12?650名孕妇，按照孕妇是否有GDM分为GDM组（2381例）和非GDM组（10?269例），再根据孕前BMI、孕期增重分亚组。各组间比较临床资料及妊娠结局，分析影响妊娠结局的相关因素。结果：在GDM和非GDM孕妇中，孕前超重和孕期增重过多均是大于胎龄儿、小于胎龄儿、初次剖宫产的独立相关因素（P<0.01或P<0.05），孕期增重过多亦是子痫前期的独立影响因素（P<0.05）。孕中期甘油三酯水平与大于胎龄儿、子痫前期、初次剖宫产、早产等不良妊娠结局独立相关（均P<0.01）。结论：控制孕期增重可以减少大于胎龄儿发生率，但孕期增重过少可能导致小于胎龄儿的发生；孕前控制BMI在正常范围可以有效减少大于胎龄儿、子痫前期及初次剖宫产的发生率；非GDM孕妇孕中期血脂水平异常可能与多个不良妊娠结局相关，需要积极的饮食指导或干预。

关键词： 妊娠糖尿病; 身体质量指数; 孕期增重; 血脂; 血糖; 妊娠结局

Abstract:

Objective:To explore the effects of pre-pregnancy body mass index (BMI), weight gain and blood lipid level during pregnancy on pregnancy outcome in patients with and without gestational diabetes mellitus(GDM). Methods:A total of 12 650 singleton pregnant women without history of hypertension and diabetes who were admitted at Women’s Hospital, Zhejiang University School of Medicine for delivery from January 2018 to April 2019 were enrolled in the study. There were 2381 cases complicated with gestational diabetes (GDM group) and 10 269 cases without GDM (non-GDM group). The pre-pregnancy BMI and weight gain during pregnancy were documented in two groups. The factors related to perinatal outcome were analyzed. Results: In both GDM and non-GDM pregnant women, pre-pregnancy overweight and excessive weight gain during pregnancy were independent factors of large for gestational age infant (LGA), small for gestational age infant (SGA) and first cesarean section (P<0.01 orP<0.05). Excessive weight gain during pregnancy was also an independent risk factor of preeclampsia (P<0.05). Triglyceride levels in the second trimester were independently associated with multiple adverse pregnancy outcomes, such as LGA, preeclampsia, initial cesarean delivery, premature delivery.Conclusions: Controlling excessive or insufficient weight gain during pregnancy can significantly reduce the incidence of LGA and SGA. And controlling BMI before pregnancy can effectively reduce the incidence of LGA, preeclampsia and the first cesarean section. For non-GDM pregnant women, abnormal blood lipid levels in the second trimester may be closely related to multiple adverse pregnancy outcomes, and active dietary guidance or treatment is also required.

Key words: Gestational diabetes mellitus Body mass index Gestational weight gain Blood lipid Blood glucose Pregnancy outcome

收稿日期: 2021-04-12 出版日期: 2021-08-16

CLC:

R714

基金资助: 国家自然科学基金（81873839）；浙江省重点研发计划（2018C03010）

通讯作者: 陈丹青 E-mail: xuheng_911@zju.edu.cn;chendq@zju.edu.cn

作者简介: 徐　恒，住院医师，主要从事产科学研究；E-mail：xuheng_911@zju.edu.cn；https：//orcid.org/0000-0002-8926-391X

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引用本文:

徐恒,马燕,张丽霞,梁朝霞,陈丹青. 妊娠糖尿病患者孕前身体质量指数、孕期增重及血脂水平对妊娠结局的影响[J]. 浙江大学学报（医学版）, 2021, 50(3): 320-328.

XU Heng,MA Yan,ZHANG Lixia,LIANG Zhaoxia,CHEN Danqing. Impact of pre-pregnancy body mass index, weight gain and blood lipid level during pregnancy on pregnancy outcome in patients with gestational diabetes mellitus. J Zhejiang Univ (Med Sci), 2021, 50(3): 320-328.

链接本文:

http://www.zjujournals.com/med/CN/10.3724/zdxbyxb-2021-0185 或 http://www.zjujournals.com/med/CN/Y2021/V50/I3/320

表 1 GDM组与非GDM组一般情况及妊娠结局比较

表 2 GDM组与非GDM组不同孕前身体质量指数孕妇一般情况及妊娠结局比较

表 3 GDM组与非GDM组孕期不同增重孕妇一般情况及妊娠结局比较

表 4 影响妊娠糖尿病孕妇妊娠结局的相关因素分析结果

表 5 影响非妊娠糖尿病孕妇妊娠结局的相关因素分析结果

表 4 影响妊娠糖尿病孕妇妊娠结局的相关因素分析结果

表 5 影响非妊娠糖尿病孕妇妊娠结局的相关因素分析结果

1	COSSONE, BENBARAA, PHARISIENI, et al.Diagnostic and prognostic performances over 9 years of a selective screening strategy for gestational diabetes mellitus in a cohort of 18,775 subjects[J]Diabetes Care, 2013, 36( 3): 598-603. doi: 10.2337/dc12-1428
2	HAPO Study Cooperative Research Group. Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study: associations with neonatal anthropometrics[J]. Diabetes, 2009, 58(2): 453-459
3	BLACKM H, SACKSD A, XIANGA H, et al.The relative contribution of prepregnancy overweight and obesity, gestational weight gain, and IADPSG-defined gestational diabetes mellitus to fetal overgrowth[J]Diabetes Care, 2013, 36( 1): 56-62. doi: 10.2337/dc12-0741
4	CATALANOP M, MCINTYREH D, CRUICKSHANKJ K, et al.The hyperglycemia and adverse pregnancy outcome study: associations of GDM and obesity with pregnancy outcomes[J]Diabetes Care, 2012, 35( 4): 780-786. doi: 10.2337/dc11-1790
5	DI BENEDETTOA, D’ANNAR, CANNATAM L, et al.Effects of prepregnancy body mass index and weight gain during pregnancy on perinatal outcome in glucose-tolerant women[J]Diabetes Metab, 2012, 38( 1): 63-67. doi: 10.1016/j.diabet.2011.07.005
6	ALBERICOS, MONTICOM, BARRESIV, et al.The role of gestational diabetes, pre-pregnancy body mass index and gestational weight gain on the risk of newborn macrosomia: results from a prospective multicentre study[J]BMC Pregnancy Childbirth, 2014, 14( 1): 23. doi: 10.1186/1471-2393-14-23
7	KIMS Y, SHARMAA J, SAPPENFIELDW, et al.Association of maternal body mass index, excessive weight gain, and gestational diabetes mellitus with large-for-gestational-age births[J]Obstet GynEcol, 2014, 123( 4): 737-744. doi: 10.1097/AOG.0000000000000177
8	GILEADR, YANIV SALEMS, SERGIENKOR, et al.Maternal “isolated” obesity and obstetric complications[J]J Matern-Fetal Neonatal Med, 2012, 25( 12): 2579-2582. doi: 10.3109/14767058.2012.716464
9	VOERMANE, SANTOSS, et al.Association of gestational weight gain with adverse maternal and infant outcomes[J]JAMA, 2019, 321( 17): 1702-1715. doi: 10.1001/jama.2019.3820
10	Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy: a World Health Organization guideline[J]. Diabetes Res Clin Pract, 2014, 103(3): 341-363
11	YANGW, HANF, GAOX, et al.Relationship between gestational weight gain and pregnancy complications or delivery outcome[J]Sci Rep, 2017, 7( 1): 12531. doi: 10.1038/s41598-017-12921-3
12	GOUB H, GUANH M, BIY X, et al.Gestational diabetes[J]Chin Med J, 2019, 132( 2): 154-160. doi: 10.1097/CM9.0000000000000036
13	BOWERSK, LAUGHONS K, KIELYM, et al.Gestational diabetes, pre-pregnancy obesity and pregnancy weight gain in relation to excess fetal growth: variations by race/ethnicity[J]Diabetologia, 2013, 56( 6): 1263-1271. doi: 10.1007/s00125-013-2881-5
14	ELLERBEC N, GEBREGZIABHERM, KORTEJ E, et al.Quantifying the impact of gestational diabetes mellitus, maternal weight and race on birthweight via quantile regression[J/OL]PLoS One, 2013, 8( 6): e65017. doi: 10.1371/journal.pone.0065017
15	COSSONE, CUSSAC-PILLEGANDC, BENBARAA, et al.Pregnancy adverse outcomes related to pregravid body mass index and gestational weight gain, according to the presence or not of gestational diabetes mellitus: a retrospective observational study[J]Diabetes Metab, 2016, 42( 1): 38-46. doi: 10.1016/j.diabet.2015.06.001
16	Institute of Medicine (US) and National Research Council (US) Committee to Reexamine IOM Pregnancy Weight Guidelines. Weight Gain During Pregnancy: Reexamining the Guidelines[M]. Washington (DC): National Academies Press, 2009: 2
17	朱丽, 张蓉, 张淑莲, 等. 中国不同胎龄新生儿出生体重曲线研制[J]. 中华儿科杂志, 2015, 53 (2): 97-103 ZHU Li, ZHANG Rong, ZHANG Shulian, et al. Chinese neonatal birth weight curve for different gestational age[J]. Chinese Journal of Pediatrics, 2015, 53(2): 97-103. (in Chinese)
18	QUINLIVANJ A, JULANIAS, LAML. Antenatal dietary interventions in obese pregnant women to restrict gestational weight gain to Institute of Medicine recommendations[J]Obstetrics GynEcol, 2011, 118( 6): 1395-1401. doi: 10.1097/AOG.0b013e3182396bc6
19	DODDJ M, GRIVELLR M, CROWTHERC A, et al.Antenatal interventions for overweight or obese pregnant women: a systematic review of randomised trials[J]BJOG, 2010, 117( 11): 1316-1326. doi: 10.1111/j.1471-0528.2010.02540.x
20	YEEL M, CHENGY W, INTURRISIM, et al.Gestational weight loss and perinatal outcomes in overweight and obese women subsequent to diagnosis of gestational diabetes mellitus[J/OL]Obesity, 2013, 21( 12): E770-E774. doi: 10.1002/oby.20490
21	HARRISONC L, LOMBARDC B, STRAUSSB J, et al.Erratum: optimizing healthy gestational weight gain in women at high risk of gestational diabetes: a randomized controlled trial[J]Obesity, 2016, 24( 1): 268. doi: 10.1002/oby.21392

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